Snakebite

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0><script type="text/javascript" src="http://hb.lycos.com/hb.js"></script> <script type="text/javascript" src="http://ratings.lycos.com/ratings/lycosRating.js.php"></script> <script type="text/javascript"><![CDATA[//><!]]></script> <script type="text/javascript" src="http://scripts.lycos.com/catman/init.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-start.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-middle.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-end.js"></script> <noscript> <img src="http://members.tripod.com/adm/img/common/ot_noscript.gif?rand=420618" alt="" width="1" height="1" />  <iframe frameborder="0" marginwidth="0" marginheight="0" scrolling="no" width="728" height="90" src="http://ad.yieldmanager.com/st?ad_type=iframe&ad_size=728x90&section=209094"></iframe>  </noscript> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" rowspan="2" width=80 BGCOLOR="#99CC99" TEXT="#080000" bgproperties="fixed" background="068846e3.gif"> <bR> </td> <td valign="top" colspan=2 height=82 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="04e8dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#336666" FACE="Arial" ><B>Dragons Wilderness Survival Club</b></FONT><B>     </b><B>|</b><B>     </b><A HREF="index.htm" TARGET="_top" TITLE="Dragons Wilderness Survival Club"><U><B>home</b></U></A></div> <div> <A HREF="id36.htm" TARGET="_top" TITLE="Basics"><U>Basics</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="Traveling"><U>Traveling</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="Food Water"><U>Food & Water</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE="First Aid"><U>First Aid</U></A>   |   <B>Snakebite</b>   |   <A HREF="id41.htm" TARGET="_top" TITLE="Bee Stings"><U>Bee Stings</U></A>   |   <A HREF="id42.htm" TARGET="_top" TITLE="Fainting"><U>Fainting</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Spider bite"><U>Spider bite</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Trench foot"><U>Trench foot</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=398 colspan=2 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="04e8dfc3.jpg"> <div> <I>Snakebite</I></div> <div>  <H3><B><center>SNAKEBITE EMERGENCY FIRST-AID INFORMATION</center></b></H3> <H4><CENTER><U><B>WHAT TO DO IF BITTEN BY A VENOMOUS SNAKE</b></U></CENTER></H4> <BR><BR> <OL> <LI>Allow bite to bleed freely for 15-30 secs.</LI> <LI>Cleanse and rapidly disinfect area with Betadine, assuming you're not allergic to iodine or shellfish) pad</LI> <LI>If bite on hand, finger, foot or toe, wrap leg/arm rapidly with 3" to 6" Ace or crepe bandage past the knee or elbow joint immobilizing it. Leave area of fang marks open. Apply Extractor immediately as well. Wrap no tighter than one would for a sprain. Make sure pulses are present. PLEASE READ DISCUSSION BELOW </LI> <LI>Apply Sawyer Extractor (see below) until there is no more drainage from fang marks.Extractor can be left in place 30 mins or more if necessary. It also aids in keeping the venom from spreading by applying a negative pressure against the tissue where the venom was initially deposited and creates a gradient which favors the movement of venom toward the Sawyer's external collection cup. </LI> <LI>If extractor not available: Apply hard direct pressure over bite using a 4 x 4 gauze pad folded in half twice. Tape in place with adhesive tape.</LI> <LI>Soak gauze pad in Betadine(tm) solution if available and not allergic to iodines</LI> <LI>Strap gauze pad tightly in place with adhesive tape</LI> <LI>Overwrap dressing above and below bite area with ACE or crepe bandage, but not too tight. No tighter than you would use for a sprain. Make sure pulses are present.</LI> <LI>Wrap ACE (elastic) bandage as tight as one would for a sprain. Not too tight.</LI> <LI>Check for pulses above and below elastic wrap; if absent it is too tight. Unpin and loosen.</LI> <LI>Immobilize bitten extremity, use splinting if available.</LI> <LI>If possible, try and keep bitten extremity at heart level or in a gravity-neutral position. Raising it above heart level can cause antivenom to travel into the body. Holding it down, below heart level can increase swelling.</LI> <LI>Go to nearest hospital or medical facility as soon as possible</LI> <LI>Try and identify, kill and bring ( ONLY if safe to do so) offending snake. This is the least important thing you should do. Visual identification/description usually suffices, especially in the U.S.</LI> <LI>Bites to face, torso or buttocks are more of a problem. Disinfect. Prep (shave hair) area with razor provided in extractor kit. Use extractor device until there is no further drainage possible and then apply pressure dressing with gauze pad and tape. ACE/crepe bandaging can not be applied to such bites. A pressure dressing made of a gauze pad may help if a Sawyer Extractor is not available. <LI>Antivenom is the only and best treatment for snakebite and you must get as much as is necessary as soon as possible. Antivenom administration should not be delayed. Up to 20 vials may be needed to neutralize the effects of rattlesnake and other crotalid venoms in North America. Children may need more than this as envenomation is apt to be much more serious in a small person compared to a larger one.</LI> </OL> <br><br> <P>*For information on the pros and cons of using an ACE bandage or low-pressure dressing on a snakebite, see the discussion below.</P> <BR> <H3><CENTER><U><B>What <I>Not</I> to Do if Bitten by a Venomous Snake</b></U></H3></CENTER> <BR><BR> <OL> <LI><FONT COLOR="RED">Contrary to advice given elsewhere DO NOT permit removal of pressure dressings, Sawyer or ACE bandage until you are at a facility ready and able to administer antivenom. As soon as the dressings are released the venom will spread causing the usual expected problems of venomous snakebite. The hospital at this time must be prepared to administer the antidote (antivenom)*</FONT></LI> <LI>Do not eat or drink anything unless okayed by medical sources</LI> <LI>Do not engage in strenuous physical activity</LI> <LI>Do not apply oral (mouth) suction to bite</LI> <LI>Do not cut into or incise bite marks with a blade</LI> <LI>Do not drink any alcohol or use any medication</LI> <LI>Do not apply either hot or cold packs</LI> <LI>Do not apply a narrow, constrictive tourniquet such as a belt, necktie or cord</LI> <LI>Do not use a stun gun or electric shock of any kind.</LI> <LI>Do not remove dressings/elastic wraps until arrival at hospital and antivenom available.</LI> <LI>Do not waste time or take any risks trying to kill, bag or bring in offending snake</LI> </OL> <P>*Remember ACE or other wide bandaging must not be wrapped so tight as to cut off systemic venous or arterial circulation. Properly applied such bandages will NOT compromise the systemic circulation.</P><BR> <BR> <H3><U><B>WHAT TO TELL THEM AT THE HOSPITAL</b></U></H3> <BR> <OL> <LI>Ask Staff to Contact Poison Control Immediately</LI> <LI>Locate nearest Antivenom Resource (for N.A. species: Wyeth-1-610-688-4400)</LI> <LI>Ask staff to use physician consultants available thru Poison Control</LI> <LI>Alternatively contact Snakebite consultants through N.Y.C. Snakebite/Jacobi Hospital, Bronx, NY (Exotic Snakebites should also contact) Emergency Hotline at 1-718-430-6494</LI> <LI>This webpage provided as a public service by the IESF and any questions may be directed to: sgrenard@siuh.edu or more expediently if necessary, at 1-718-227-6234. Beeper: (for emergencies only) 1-917-354-8289. After three tones enter your call back number, be sure and include area code and country code (if necessary) and then push #sign. </LI> <LI>Questions on snakebite may be posted to the venom list. If you are not a member please go to the <A HREF="http://www.xmission.com/~gastown/herpmed/venom-l.htm">VENOM LIST Website @ http://www.xmission.com/~gastown/herpmed/venom-l.htm</A> Or write the moderator to be subscribed at: venom@icomm.ca.</LI> </LI> </OL> <BR> <HR> <HR> <H2>IT GOES WITHOUT SAYING BUT WE'LL SAY IT ANYWAY......</H2> <OL> <LI>Never hike, camp, work or collect specimens in areas where there are venomous snakes unless accompanied by at least two companions. One to stay with the victim and the other to go get help. All parties should know what to do.</LI> <LI>If you come across any snake in the field and don't know positively what it is or isn't, do not approach it, try and examine it or photograph it (unless you have a long telephoto or zoom lens). Move away from it as expediently as possible.</LI> <LI>If you work with venomous snakes in a public (zoo/exhibit) or private collection or in a museum or university laboratory, never open their cage without a companion nearby who is familiar with snakebite first-aid</LI> <LI>A telephone with an outside line should always be located in the room or area where venomous snakes are located in case there is a need to call for help.</LI> <LI>Never handle or attempt to handle venomous snakes without at least one trained companion present</LI> <LI>If you are not an experienced venomous snake handler, don't try handling or catching them without first obtaining extensive experience and training by someone who is trained</LI> <LI>If you maintain a private or laboratory collection of live venomous species, keep all cages under lock and key; rooms where such cages are located should have a double door and vestibule, be completely visible through glass paneling from the outside and be off-limits to all but authorized personnel. If a snake appears missing from a cage you may be able to locate it before entering the room in preparation of re-securing it. Such rooms should be completely sealed. No open or screened windows and no "mouse-holes" or pipe holes through which a snake can escape. Sink drains should be also be capped and toilets, if present, always kept covered.</LI> <LI>Finally if you deal with venomous snakes always make sure you have or know where to locate a supply of specific antivenom for the species you are involved with.</LI> </OL><BR> <BR> <H3>WEBSITES OF RELATED INTEREST</H3> <H5><a href="http://biomed.nus.sg:80/PID/PID.html">Poisons Information Database</a></H5> <H5><A HREF="http://www.xmission.com/~gastown/herpmed/venom-l.htm">Venom Listserv</A></H5> <H5><A HREF="http://www.xmission.com/~gastown/herpmed/phibia.htm">New/Used Reptile-Herpetology Books</A>Includes many titles related to venomous snakes and snakebite.</H5><br> <H5><a href="http://www.xmission.com/~gastown/herpmed/">Herpmed's Homepage</a></H5> <H5><a href="http://www.xmission.com:80/~gastown/herpmed/aubite.htm">Australia/PNG Snakebite Page</A></H5> <H5><a href="http://www.pitt.edu/DOC/95/30/32686/Wemsi.html">Wilderness EMS Institute</a></H5> <H5><a href="http://www.xmission.com/~gastown/herpmed/med.htm">Herp Medical Page</A> -- Go here for links to venomous snake and other snakebite website links.</H5> <HR> <H3><B><CENTER>PLEASE READ THE FOLLOWING DISCUSSION:</CENTER></b></H3> <P>This document suggests the use of containment or sequestration of injected venom at or near the bite site using broad (3"-6" wide) compression bandaging such as crepe or ACE(tm)-type elastic bandage. This is the standard worldwide accepted first-aid treatment for bites by elapid snakes such as cobras, coral snakes and many Australian species. This method has delayed on the onset of serious snakebite symptoms as long as 24 hours in Australia where victims of deadly bites were that far from medical assistance.The method remains controversial in the U.S. although a number of top snakebite experts have recently recommended its use in crotalid bites in printed references appearing in peer-reviewed journals.</P> <p> The use of containment/sequestration for certain types of North AmericanTpit viper (rattlesnake, moccasin and copperhead) bite is felt by some to increase the risk of disfiguring local tissue injury, which, while not necessarily life- threatening by itself may necessitate skin grafts and extensive repair and treatment once the acute, life -threatening phase of the event has passed.Some experts feel the spread of venom to vital organs can be life-threatening and that you have no way of knowing how life-threatening a snakebite is in the first moments of the event. Therefore, users of this method must recognize that there is a trade-off: containment as a life-saving measure at the risk of local tissue damage which while not necessarily life-threatening, could be disfiguring, painful and/or which could require prolonged and extensive follow-up treatment. We therefore urge readers who decide to use this method on ANY type of snakebite to do so as a life or death decision and to make this decision in pre-recognition of the above information. In addition some U.S. crotalid bites, particularly from large species, results in widespread damage to limbs even when bites were to digits and hands or feet. Thus the wide-area, low-pressure wraps can prevent the spread of venom and more widespread damage. Again some experts feel that this increases the intensity of more localized damage . So while snakebite mortality without these dressings may be low, we have been appraised of too many unnecessary and tragic deaths and widespread disfigurement without its use and in general advocate its use if it is properly applied. Disfiguring local injury can be limited to a much smaller area compared to crotalid (pit-viper: rattlers, copperheads, cottonmouths) snakebite where this type of containment has not been used. Compression bandages are standard in Australia but these are mostly elapid bites although some have some SERIOUS local tissue or muscle effect as well. The venom of the King Brown Snake, a widely distributed species (<i>Pseudechis australis</i>) has as its main target: skeletal muscle tissue. Bites by Cobras which also have local effects also have direct acting cardiotoxins so containment can be life-saving in bites by these snakes. We strenuously oppose the out of hand dismissal of containment, used in Australia for nearly 20 years sucessfully, by a few experts in the United States. Denial of the value of this method by these U.S. experts has resulted in the death of professional and hobbyist handlers of cobra and other elapid snakes who erroneously were led to believe that the method should not be used because of their admonitions that local tissue destruction is its only effect and should NOT be used under any circumstances. A number of advocates of the method have been bullied and threatened by a few others who are opposed to this treatment because they say there is no proof it is of value in rattlesnake bite but they can point to no studies which disprove its worth whereas there have been animal studies done using Diamondback rattler venom on pigs and monkeys demonstrating that it serves to prevent spread of venom and suppress widespread swelling.<br> <HR> <H2><CENTER>IMPORTANT REQUEST</CENTER></H2> If anyone reading this has been bitten and envenomated by a rattlesnake, copperhead or cottonmouth or water moccasin and has used ACE or crepe bandaging and/or the Sawyer Extractor .....we have questions for you and would like to have a copy of your medical case history. This is an urgent request in order to prove or disprove the value of this method in such snakebite. Only cases where there was proven envenomation, admission to a hospital and antivenom administration are solicited. E-Mail: sgrenard@siuh.edu or call Steve Grenard at 718-227-6234. Thank you.. <HR> <B>This document is for informational purposes and no liability is assumed in its use. Always consult with a competent medical professional regarding health related issues. Because of its rarity, some doctors know little or nothing about snakebite management so one should always request that they contact a Poison Control Center and ask to be placed in direct telephone contact/consult with a physician who is experienced in this area. A number of tragic deaths clearly have occured due to gross neglisence and medical mis-management as a result of this ignorance and failure to obtain competent consultative advice..</b><br> <HR>  </div> </td> </tr></table></body>